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BOARD OF TRUSTEES • <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodl <br /> Anthonatt <br /> Patricia Vannuccl, sec'y. 1601 East Hazeox u <br /> Hazelton Avenue, P. O. B2009 San Joaquin Cont <br /> tla Van Spronsen y <br /> Earl PCity of Escalon <br /> Fern Bupbae imentel Stockton, California 95201 City of Manteca <br /> Daniel L. Flores 209/466-6781 Clty of Ripon <br /> John D. Mast, M.D. City of StocktonCity of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne Love San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at A )0/ 5- 1�)_ ockfwj,4z &-t:>1i <br /> hereby authorize 1114 (ss f/SSncrc rs <br /> to release any and all analytical results , geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> Owner/Operator: �i; G Title: <br /> Address �['/S Gy6� zfJ �Q� Phone: <br /> Date: <br /> EH 08 05 <br />